By necessity all advancement flaps must be designed so that the advancing border of the flap also represents a margin of the cutaneous defect that the flap is designed to repair. Lateral view of v y advancement flap inset into defect of ring finger.
The boxy appearance seen intra operatively will soften smooth out and re contour with time and gentle massage.
Vy advancement flap. Patient demographics symptom duration previous treatments short term postoperative outcome and long term follow up were recorded. 5 2b 5 3 and 5 4. All patients with chronic anal fissures regardless of their previous management underwent v y advancement flap.
Advancement flaps may be categorized as unipedicle bipedicle v y y v and subcutaneous tissue pedicled island flap table 9 1. The use of a single v y plasty has. 2 the technique can be used in various other sites within the head and neck and its use seems to be gaining popularity particularly for reconstructing scalp.
This advancement flap is commonly used in the reconstruction of defects located in the cheek region 1 or in the upper lip. 4 6 10 the v y plasty advancement flap technique. But a simple v y plasty pedicle flap easily can be advanced to cover the defect left by fingertip injury.
The flap geometry corresponds to a v y advancement and the secondary defect is closed by mobilizing the surrounding skin figs. We wished to assess anal advancement flap as a treatment for all chronic anal fissures. The flap described is most like the flap repair to correct a whistling lip deformity 8 9 kapetansky 9 popularized this repair in bilateral cleft lip repairs to correct a defect in the upper lip associated with a small prolabium.
A single v y flap does not require this and the donor defect closes primarily. The v to y advancement flap has many uses in the reconstruction of skin defects at various head and neck sites. Because these flaps receive a good blood supply from the supratrochlear artery on one side the pedicle can be kept relatively thin allowing for good mobilization and downward rotation of the flap.
This patient underwent mohs surgery with surgical repair with a v y advancement flap. Patient 8 days post surgery. A cross lip flap would also be difficult to perform on a child or young adolescent.
Volar view of v y advancement flap already inset into ring finger defect. V y advancement flap drawn out on volar surface of ring finger. Early follow up at 2 months shows some mild pincushioning that could be improved with intra lesional steroid and some prominence of the suture line including from the leading edge of the flap that could be blended with a fractional ablative laser.